Antipsychotics Do More Harm than Good In Dementia Patients

Jun 24, 2008 | Parker Waichman LLP

Antipsychotic drugs use to reduce symptoms of agitation, aggression, and violence in dementia patients is on the rise, as can be seen in soaring sales of antipsychotics like Risperdal, Seroquel, and Zyprexa. These drugs experienced a $4 billion dollar increase in sales since 2000 for a total of $13.1 billion in 2007, due, in part, to an increase in such prescriptions in nursing homes. As a matter-of fact, researchers estimate that nearly 30 percent of all nursing home patients have received antipsychotic drugs at one time or another.

But, a 2006 study of Alzheimer’s patients revealed that in most, antipsychotics provided no significant improvement over placebos in treating aggression and delusions. A year earlier, the Food and Drug Administration (FDA) ordered newer antipsychotics be labeled with a “black box” label warning of an increased risk of death. Last week, the FDA required a similar warning on older antipsychotics, as well. First generation antipsychotics, like Haldol, carry a significant risk of repetitive movement disorders and sedation. Second-generation antipsychotics, called atypicals, are commonly prescribed because the risk of movement disorders is lower; however, they can cause sedation and can contribute to weight gain and diabetes; some experts cite a lack of research for these drugs used in behavioral problems. If patients begin showing behavioral symptoms of dementia, doctors said, they should have complete medical and psychiatric workups first, especially if symptoms develop suddenly.

The FDA has not approved marketing of antispychotics for older dementia patients; however, the drugs are routinely prescribed “off label.” Off-label prescribing is perfectly legal and left to the discretion of the prescribing physician; marketing of drugs for off-label, unapproved purposes is illegal and several states are suing big name antipsychotic drug makers on charges of false and misleading marketing.

Other, recent research revealed community-dwelling adults receiving a prescription for a newer antipsychotic medication were 3.2 times more likely than individuals who received no antipsychotic therapy to be hospitalized or to die during 30 days of follow-up. Those who received older antipsychotic therapy were 3.8 times more likely to have such an event compared to those who received no antipsychotic therapy. In nursing home groups, those taking older antipsychotics were 2.4 times more likely to be hospitalized or die, while those taking newer drugs were 1.9 times more likely to die or be hospitalized during the 30 day follow-up. Meanwhile, a recent British study concluded that the continuing use of antipsychotic drugs provides neither cognitive nor neuropsychiatric benefits when taken by Alzheimer’s patients.

Some nursing homes are trying a different approach, so-called environmental intervention, tactics that include reducing boredom, providing intellectual and physical stimulation, exercise, calming music, pet therapy, and improving how staff approaches and talks to dementia patients. Such approaches are time consuming, do not help all patients, can be prohibitively expensive, and are more difficult to provide as Alzheimer’s continues to increase. Also, nursing homes are understaffed and insurers do not typically reimburse for the type of one-on-one psychosocial therapy that advocates recommend. Despite dangerous side effects, sedatives and antipsychotics, are often prescribed because they offer a quick fix.

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